Monday, January 19, 2015

It amazes me that I have been following this sparse diet for weeks, healing from surgery, following the letter of the law as my doctor and nutritionist have recommended, losing weight throughout it all, and yet, I can still worry fervently that this surgery is not working.

I have been around the same weight for a week now, hovering between 43 and 45 pounds lost. It is a stall, I guess, but I don't know how much it counts, given that I lost over 6 pounds the week that I had stomach flu. Even so, even if I hadn't lost a pound when I was sick, and I was still stalling here, it would be completely normal. There is no need to worry. 43 to 45 pounds is a lot of weight to drop, and my body needs time to adjust.

My doctor's materials make all kinds of notes not to weigh yourself too often, or to worry about the results. "Just do the work, and let the results follow."

Huh.

I have one more day, officially, of the soft solid diet, and then on Wednesday, I am cleared to have at it. Try new things. Go crazy and eat something crunchy, for instance. Even with soft foods, I am inching my way to my new normal. Today, I had a lean breakfast sandwich: multigrain bread, egg white, chicken and apple sausage, and a bit of cheese. The whole thing was really perfect, split in half and eaten for two meals, because I couldn't get more than a few bites down at a sitting. Two hundred calories, with 16 grams of protein. By all accounts, a great choice.

And yet, there I was, thinking, "Oh, no. This is bread. I haven't had bread in over eight weeks. What on earth am I doing?!? Now I'm going to start having wild food cravings. Tomorrow I'm going to have gained five pounds."

That, my friends, is the screwed uped-ness of the thinking, the obese mind trying to make sense of the obese-but-forcibly-losing-weight body.

I simply can't fully believe this is working. I think I'm afraid to hope, and a part of my brain is saying, "Hey, 40+ pounds, look at that! Not ideal, but you can live this way. You feel so much better. If you do everything right, and it just doesn't work, this will be just fine."

It's meant to be helpful coping thinking, I'm sure, but it leaves me feeling afraid; afraid to move to a regular diet, afraid to reintroduce any complex carbohydrates (lest I interrupt the weight-loss machine that has been my body lately), afraid to be part of the 1-5% for whom this surgery isn't effective.

Screwed uped-ness lives.

It has been so long since I have really lost weight, significantly, it just seems impossible that the consistent weight-gaining pattern of (almost) my entire adult life could end. No amount of my work or dedication on my part can completely shake this feeling, and the more normal my diet and life becomes post-surgery, the more I think, "Somehow, this is going to end."

Even worse, I think, "Somehow, this is going to end, and it is going to be my fault."

I know, rationally, that something about my body helped to trigger or fuel my obesity, beyond my behaviors or choices. It was never all my fault, as if fault should even be assigned in such a matter. I know that all the shame that I have felt as an adult for being obese—primarily because I assumed all thin people I encountered thought me lazy and gluttonous—was pointless, and only made the problem worse. If I didn't think that I needed a medical intervention in order to treat this, I wouldn't have pursued one, and the results of this intervention are clear: you can't eat much, you aren't hungry much, you lose weight, end of story. All that said, old thinking patterns—even ones that I have worked hard to address—can still strong-arm the new thoughts, the ones that only began to take root in December, as I witnessed my pre-op diet work effectively.

Is this working? I can't know. I can only do what I'm supposed to do. I can only move forward. It would be shocking if it wasn't working, practically speaking, but to my brain, it is shocking that it even could.

Do you have your own screwed uped-ness of the thinking, those patterns of thought which remain indentured from an older version of yourself, but that don't match your current life? I can't imagine that the obese have the whole market on this. If so, come join the evolution, where we see the old thinking, recognize it for what it is, and kindly tell it that is doesn't work anymore...over, and over, and over.

Saturday, January 17, 2015

For those who are regular blog readers, and specifically momblog or dadblog readers, today's entry might feel vaguely familiar. This post begins a series, which will effectively be my surgical equivalent of "the birth story," the often anticipated post after a parentblogger has been writing about an upcoming birth for months, and then sinks into the black hole of exhausting infant care, and is unable to post the actual details of the birth for a few weeks.

It took me FOREVER to post a birth story after having EJ, mainly because the birth was so darn horrific, way beyond the norm (as if the norm isn't just a freak show to start), and I just couldn't get pen to paper, so to speak. I didn't even want to think about it, and I certainly didn't want to scare anyone else. I believe what I wrote was pretty cursory, and within the following years, my blog revealed more details of the event as they were germane to new thoughts and feelings.

But, hey, here's the good news, readers! For those of you who are interested in what my experience of receiving a vertical sleeve gastrectomy was like, I can tell you this: it was MUCH better than birth! Maybe 10,000 times better? That sounds about right. Of course, I didn't get an adorable baby out of it, but I sure am sleeping better than I did when I came home with a baby.

So, for those who have been interested, here is the first in a series in which I flip back in time just over a month, and give my play-by-play account of my surgery experience. For those interested in this same surgery, and who may have questions, feel free to leave a comment with your contact info, and we can chat directly.

Pre-Surgery Week: Deciding Where to Go

After several years of research, attending informational sessions, and going back and forth with our insurance company, we got the final word that there would be no way that my surgery could be covered via insurance.

THIS IS A MAJOR SCAM. Obesity kills people, and bariatric surgery shows the most promising outcomes for helping to combat obesity, in conjunction with health behavior changes. I could go on and on about the silliness of all this, but suffice it to say, this isn't cosmetic surgery, and I hope that insurers stop thinking of it as an expensive elective soon.

At that point, I knew I would not be able to have the surgery here in Chicago, as the local (amazing) hospitals did not have a fixed, set rate for the surgery, which meant that I could pay as much as $55K once all the costs were covered. I felt pretty despondent, but after reaching out online to communities of people who were having/had recently had vertical sleeve gastrectomy, I discovered that affordable options were available if you were willing to travel.

For those in America and Canada who want to self-pay for surgery, the main affordable option is Tijuana, Mexico. For a set price (minus airfare), you can fly to San Diego, get picked up at the airport, brought to the hospital, receive surgery, get put up in a hotel after you are discharged, then brought back to the airport 2-3 days later. I had heard rave reviews online, and began calling different practices to determine who might be best.

Here's where things got complicated. There is an entire world of marketing and competition that happens in this industry, and surgeons have coordinators and staff members specifically hired to encourage you to use their practice, and to avoid others. Some folks had nothing negative to say about other doctors, others used vague jabs and innuendo to let you know other doctors were really not as safe, and a few basically called out others as butchers or hacks.

I found this entire process very difficult to swallow. I talked to some really great coordinators and some very thoughtful surgeons, and I know (through meeting others online who have had surgery in Mexico), that many of these doctors have excellent outcomes. Still, though, as an intuitive, it was hard for me to decipher through the propaganda to figure out who was best in this market. In addition, different doctors had wildly differing techniques, none of which I could verify as best practice through my own research.

It occurred to me around this time that, for general surgery, if you have a great local referral and good insurance coverage, you likely wouldn't ask so many technique questions. There was something about having to seek out providers, and having it completely in my own purview to make the decision, that brought me straight back to my days as a health care researcher. I simply could not get enough information. The problem: the more information I received, the less clear I was about my choice.

Throughout this entire discovery time, I posted my insights on Facebook, and got a lot of feedback from friends who work in health care. One of my former colleagues (when I was a health care researcher), who went on to become a registered nurse, reminded me to think volumes. Every surgeon can have complications: sometimes the best surgeons have higher complication rates, actually, because they work on the trickiest cases and/or the sickest people; volumes are the key to becoming an expert technician. It was nice to have my memory jogged about such an important point, especially as I was sifting through varying reports of outcomes for different surgeons via phones calls and online searches.

Around this time, I went back to a post I had made on a sleeve community forum, asking for self-pay physician referrals, and remembered that someone had recommended a surgeon in Michigan, only four hours away. I had also found a different self-pay doc in Michigan, one who has a terrific series of videos about obesity, the surgical options, and healthy eating/exercise.

The first doc, Dr. Pleatman, was described as an excellent surgeon, but not the best interpersonally. The second, Dr. Weiner, was so engaging on screen, I wanted to find out more.

I made appointments with both, and was happy that, unlike with Mexico, I could meet these surgeons in person, not just online. I hit it off immediately with Dr. Pleatman's coordinator/receptionist, Cari. She was friendly, personable, and not the least bit a salesperson. She's a great ambassador for his practice. She also warned me that the doctor is not very "touchy-feely," or something like that, which was consistent with what I had heard from his previous patient. That's not why we hire surgeons, of course, so I wasn't deterred. When I called the second doctor, they were hesitant to book me, as I wasn't local, and had to get specialized approval.

Dr. Pleatman called me the evening I first spoke to his office, and I found him extremely personable. I was surprised I had heard otherwise. He was patient, went through my medical history on the phone, and made me feel hopeful.

A few weeks later, I travelled to Michigan, stayed with my aunt and uncle, who made me delicious meals and fancy cappuccinos, and interviewed both doctors on a whirlwind day.

In the end, I chose Dr. Pleatman, for a variety of reasons, and I am so glad I did. While surgery in Michigan is twice the cost as surgery in Mexico, it was one-fifth the cost of surgery here, so still a bargain. While I highly recommend Dr. Weiner's videos—truly, if you want to understand obesity, how this surgery works, what kind of diet is best, etc., he is your guy, and I am so grateful for what I learned from him via these videos—the main reasons for choosing Dr. Pleatman were, as follows:

Volumes: Dr. Pleatman had performed at least 3 times as many surgeries, and that is just within recent years; beyond comparison between the two surgeons, specifically, his volumes are excellent (with a low complication rate, too.)

Facility:The hospital at which Dr. Pleatman performs surgery was fantastic, and when you come from out of town, and don't know hospital reputations from local chatter, it is nice to find such a modern, well-equipped, and quite frankly, aesthetically lovely place to have surgery waiting for you. My aunt in Detroit, who is a nurse, liked that it was a part of the Catholic health system there, which she recommended. I like a nurse's approval!

Out-of-Town Accommodations: From material on their (robust) website to the services provided at in-person visits, Dr. Pleatman's practice has everything worked out to ease this process for out-of-town patients. I got a special rate at a hotel just minutes from the office and the hospital that had a kitchenette (to make eating my specialized food easier), and received an hour-long consultation with both the nutritionist and the patient-care coordinator, with accompanying reference materials, diet plans, exercise plans, and dates to remember to take home.

Trust: I trusted him, from the start. I realize this is intangible, but it may be the most important factor of all.

(There are a few additional reasons why I made the decision I did, and if you are someone considering this surgery with either physician, I would be happy to share my insights, privately. For public consumption, this is all I want to share.)

Once home, I began the process of ordering protein powders and vitamins, and starting my two-week pre-op, liver shrinking diet. I received great online support from Dr. Pleatman's nutritionist during this time, and the results were terrific.

Interested in more? Stay tuned for more on my beautifully-small liver and my actual surgery!

Friday, January 16, 2015

I know these photos aren't great—the first is from surgery morning, so I'm still in my jammies at the hotel, and in today's follow-up pic, the room is really dark, as most of the lightbulbs have gone dead. I'd fix them, but I can't reach them, even with a step stool. Ah, being short. Please send official complaints for the weird computer brightness in this shot to my tall, capable husband, who isn't the least bit troubled by an inability to see while getting ready in the morning. He doesn't often check personal email or Facebook, so it won't bother him at all, I promise.

Don't send complaints about my jammies, though. I had enough on my mind that day, I'm owning that look 100%

Thursday, January 15, 2015

Today is the first day since my surgery that I really felt some get-up-and-go energy. I almost didn't recognize myself.

I am not a morning person, and as our child has transitioned from needy little one to capable school-aged one, my husband usually humors me by letting me sleep a little past the alarm while he helps the kiddo with breakfast (if she needs it.) It's a lucky arrangement for me, because there is almost nothing I like better than getting to sleep in.

(I once received a Garfield-themed, "I don't do mornings." nightgown as a teen, much like this one, except more 1980s, on a preppy fuchsia/mulberry background. My morning preferences have been long established.)

The trouble I have is that if I start to string too many of these mornings together, and he happens to have too many busy mornings in a row, I discover that I am, in fact, expected at wake-up by the rest of the family, lest I have forgotten.

During post-op recovery, though, my mornings have been late, and no one has had any worries about it. I am tired a lot, not the kind of tired one feels from a stressful or busy day, or a late night, but fatigue in the body that says, "Hey, don't forget, you got cut open a few weeks ago." I'll go for a few hours, feel really good, then WHAM, there it is. Deep, down tired. I really should be napping every afternoon, if I a) had the time, and b) were smart about this whole recovery.

(I have mentioned here that I am totally off caffeine, right? Yeah. That's some tough stuff to work without.)

Having the stomach bug last week didn't help, of course. Dehydration, already setting in because of the cold, dry Chicago air, was quadrupled, and as I can't throw back anything more than a few sips of water at a time now, it is hard to turn around.

This past month, when the alarm has sounded, I have usually been so zoned out, I just fall back asleep for awhile, if I have even fully woken up. Sometimes I haven't even heard it, then wake up startled much later, to find that everyone is fine, lunch is packed, and the kiddo is about to head out to school with the hubby. Even for me, a late sleeper, this has been out of the ordinary. It is weird to try to jump into work without a warm-up.

This week, though, was a bit of a breakthrough. I realized a few days ago that, once again, like before my surgery, I was instinctively waking up a few moments before the alarm. Pre-surgery, I would have gone back to bed, and just hit snooze a few times. What I noticed beginning this week, though, was that I have been feeling more awake when I wake up before the alarm than I ever did pre-surgery. I think I need to sleep longer, and I go back to bed and really try, but then...hang on...I discover that, "Nope, I'm well rested and ready to wake up." My body feels a little more refreshed, a little more recharged, and it is...odd. It is also wonderful! Exciting! Hopeful! Still, even though it is great, really, it feels very, very odd. Who am I?

My little endomorph self doesn't quite know what to do with a revved up metabolism.

Today, I awoke to "Let It Go" being played on our tablet, which EJ usually takes to her room to use as her alarm. Last night, she left it in the living room, so just about the only person who wasn't going to wake up to it was her, sleeping on the opposite end of our home. Interestingly, though, Mike didn't hear it either.

(How? I don't know. I really, really, don't know. It was so much broadway-style singing with inspirational lyrics. Who sleeps through that?)

I got out of bed and brought the tablet in full Idina Menzel to EJ's room, stopped in the bathroom, then planned to go back to bed. I put on my CPAP mask and snuggled in. Then our alarm went off, and unlike any other morning since I had my operation, I got up and started the day. I had had enough sleep. I wasn't groggy. I made a great start. I then proceeded to have an energy-filled day, including some writing, a visit to the acupuncturist, school pick-up, then errands with the kiddo. I'm planning to cook a whole dinner tonight: salmon, cauliflower mash, and some asparagus. I can feel the tired starting to creep in a bit, but it's 5:30 p.m., much later than any other day's onset of fatigue.

I don't know what my current 40+ pound weight loss means for my blood pressure, my cholesterol, or my blood sugar right now, as I haven't had those tests done. What I can say is that my back hurts less, I'm sleeping better, and I have more energy than I have felt in longer than I can actually remember.

Wednesday, January 14, 2015

This post is sponsored by Speck Products, who provided me with some lovely Speck cases to try out and write about here on the blog. All opinions presented here are my own, or those of my family members who have sampled the Speck cases along with me.Did you get a new iPhone for Hannukah or Christmas? Speck has got you covered!If you didn't receive one of those lovely new gadgets, don't worry! Speck has products available for all kinds of phones, tablets, and laptops. Speck kindly offered one phone case, one tablet case, and one laptop case for us to sample, and I am happy to report that we like them all. Here's our reviews:1) iPhone CaseMy father-in-law graciously offered to review a new iPhone 5 case, and it couldn't have come too soon. Dad's OtterBox case had begun to fall apart, the rubber peeling away and getting sticky. He chose the CandyShell + FACEPLATE iPhone 5 case in Black/Slate Grey.After having to fool around with it a little to get the faceplate on without air or dust behind it (my husband had this same issue), he has since reported that he loves it. He likes the look and the feel (slimmer than the OtterBox, shinier, but still with grips to hold), and says the buttons work well and plug-ins are easy to access (something that was less optimal with his old case.) If you have an older phone going the distance, a Speck case is a nice way to keep your phone safe and stylish.2) iPad CaseSpeaking of going the distance, let's talk for a moment about the iPad 2. You know, that iPad so many of us purchased a few years back, and is still going strong? Sure, I'd love a fancy new iPad Air. I'd also like a new car and a beachy vacation home. None of these items are in our budget, and I can say that our iPad 2 fits squarely into the category: "If it ain't broke, don't replace it."Unfortunately, the snappy magnetic cover that I purchased from Apple along with the iPad 2 did not hold up. I was able to purchase another one, but it is gray, blah, and provides little protection for the device.I like color. Speck to the rescue! I am very excited to report that the case we tested, the Slim-Fit Protective iPad Case and Adjustable Viewing Stand, is currently on sale for $19.99 (usually $39.99.) It does add a little weight to the device, but also adds protection and versatility, with two ways to fold it in order to use your iPad in different configurations for viewing and typing.I like this case because the color and utility of it make me feel like we have a brand new device. I have found that it is hard to hold it's position in typing mode, and wish it had a feature that allowed it to be propped up in portrait, not just landscape. All told, it is really nice to have our old device looking and feeling new and snazzy. Given that it can be hard to find cases for older devices, it is nice to have a variety of colors and patterns available, too.3) MacBook CaseThis was the big-hit winner of the holiday season this year. My husband's laptop is now adorned with a MacBook Pro SeeThru Case in deep blue. He loves it. LOVES it. Is there something bigger than love to say here?The case, itself, does not add a lot of weight to the computer, it protects it well, and it is really beautiful. The light from the apple on the back of his computer glows through the case, and is very striking. I think he is officially converted from "my computer doesn't really need a case" to "I am never taking this case off."I'm a Speck fan, as you can see. Check 'em out, friends.

Tuesday, January 13, 2015

Four weeks ago today, on December 16th, I had a vertical sleeve gastrectomy. It was performed in Michigan by a surgeon and at a hospital that accepts self-pay patients at a set rate that was more affordable than local Chicago facilities. It required a whirlwind of preparation and help from family, but now looking at it in the rear-view mirror, I wouldn't have done it any other way.

Those of you who follow me on Facebook and other social media already know all about this, as I've been posting #postop notes, and gratefully taking in all of your kind well wishes. Thank you, a million times, THANK YOU. It has taken me awhile (and some starts and stops at the keyboard, unusual for me) to begin to write about this subject here. This will be the first of many posts on the subject, provided in the tiny bite-sized chunks that mirror my actual eating pattern these days.

What a month.

When I speak to others who have had bariatric surgery, or read articles concerning the subject, I often hear the frustrated, "If someone tells me this is the easy way out, I'm going to...[insert empty threat.]"

Does anyone really think this is easy? Truly? I haven't heard anyone say that to me, and I certainly don't think much about what has happened in the past month has been easy. For people like me, who have felt trapped with a seemingly intractable form of obesity, this surgery is certainly more effective, but easy, not so much.

I have had well-meaning folks try to warn me about how hard the work will have to be for the rest of my life. How I must be mentally prepared, how I'll need to eat differently, how I can't just skip exercise, how I really have to commit. (I feel like getting cut open and having the majority of a major organ removed is a pretty good indication of commitment, but I digress.)

Here's a truth that I'm sure a lot of fit/skinny people might be uncomfortable to hear: many fat people have lots of experience with strict diets and exercise regimes, maybe as strict or stricter than their less heavy friends. The difference? For many of them (myself included), their bodies have not responded as well.

It feels better to believe that your body is entirely your making, I get it. I wish that were true. It just isn't. I'm no different than I was before surgery when it comes to my need to really, really watch what I eat and really, really work at my fitness. I've done it before, many times, sometimes more successfully (when measured in pounds) than other times. I have also just said, "Screw it," and stopped caring about all that for months at a time, suffering the consequences. Isn't that true of some "normal sized" people too, though, typically right around the holidays?

So don't worry, friends, I understand my predicament. I've lived my weight predicament for my entire adult life. I have no idea where my body size/weight will end up after the initial kick-in-the-pants from this surgery, but I know that paying attention to my lifestyle will be the long-term key to success.

For now, I'm on my last day of eating puréed and liquid foods, moving tomorrow to soft foods, then in a week, I'm cleared to eat just about everything, save for really crunchy raw vegetables, etc. I have been following my guidelines to the letter of the law, rule-follower that I am, save for a lack of walking around on days with extreme cold, or last week, when I got stomach flu. (I don't recommend getting a stomach bug while recovering from stomach surgery, btw. It is a horror show.)

In some ways, this experience has been a lot like having a child for the first time. You can prepare, you can anticipate, you can do all the work necessary, but you really don't know how it is going to shake out or how you are going to feel until you are already fully committed, past the point of no return. I am pleased to say that most of my worries about potential recovery complications have not come to pass, and I am getting used to my new life through experience.

One difficulty did really surprise me, though, and I don't remember reading about it or discussing it with others who have had the surgery before I went under the knife. It has been extremely isolating not being able to eat. I'm not hungry, thanks to the mechanism of the surgery, itself, and getting enough protein and calories in everyday is a challenge. The hard part, for me, has been not being able to sit at table and participate with the family and friends at mealtimes or celebrations. I managed to make it through the Christmas and New Year's holidays on a liquid diet, which I am putting down in my list of "life's greatest accomplishments."

I am grateful that I am so close to the finish line of this stage, at which point a new set of challenges will present themselves. Tomorrow night, as I move into soft foods, I am heading out to a restaurant for the first time since surgery, for a girls' night out. I checked out the menu online, then called to confirm that some of the softest foods mentioned are still current menu items. I am both thrilled and terrified to make this transition, but that has been how each stage of the pre- and post-op experience has been, so I'm not surprised. I've become increasingly comfortable with this intensity of opposing emotions right before a shift occurs. I laugh, I cry, I ride it out, it all feels okay.

For those who care about these things, I have lost 43.9 pounds as of this morning. At my pre-op visit on Monday, November 24th, I was 3 pounds down from my highest weight, measured a few weeks before. I then went home, enjoyed Thanksgiving without going crazy, and started a pre-op, protein-rich, low-to-no carb, no sugar diet to shrink my liver before surgery. I lost 18 additional pounds before my surgery, two weeks later, bring my total pre-op loss to 21 pounds. With 22.9 additional pounds lost this month during my recovery, I've already improved a lot of my potential risk factors, while still understanding I have a long way to go.

On the left, I am in my jammies at the hotel in Michigan, right before leaving for surgery on December 16th; on the right, I'm standing in our kitchen this past Sunday, anticipating the Packers playoff game against the Cowboys (with one of my biggest cheerleaders.) Small difference? I think so. No big drop in size yet, but I can button my wool coat over my heaviest fleece, and not be so stuffed in I can still use my arms to drive. Is that a good Midwestern measure? I'm going with it, with a giant smile on my face.